Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients Clinical article
Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients Clinical article
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DOI：
10.3171/2008.10.jns08993
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发表时间：
2009-08-01
影响因子：
4.1
通讯作者：
Nathoo, Narendra
中科院分区：
文献类型：
--
作者：
Narotam, Pradeep K.;Qiao, Fan;Nathoo, Narendra
目的。后颅窝手术后并不总是能够完全闭合硬脑膜，通常需要移植物以确保完全闭合。作者报告了他们使用胶原基质作为覆盖硬脑膜移植物修复后颅窝硬脑膜缺损的经验。方法。对 52 名接受后颅窝胶原基质硬膜成形术的成年患者进行回顾性分析。分析了与硬脑膜移植直接相关的并发症、脑积水的存在与否，以及闭合吸引伤口引流在术后假性脑膜膨出中的作用。结果。后颅窝手术的适应症为肿瘤 32 例，血管异常 9 例，自发性小脑出血 11 例。 23 名患者（44.2%）采用闭式吸引伤口引流。 52 名患者中有 48 名 (92.3%) 硬脑膜缺损 >2 cm。 9 例（81.8%）脑积水患者需要脑室腹腔分流术。手术并发症包括2例患者出现假性脑膜膨出（3.8%；未进行伤口闭合吸引引流）； I 例患者浅表伤口感染（1.9%；采用封闭式吸引伤口引流）； I 患者出现不明原因的嗜酸性粒细胞增多。结论。使用胶原基质的硬脑膜成形术在后颅窝中安全有效，并且易于使用且省时。细致的分层伤口闭合、脑积水的检测和有效控制以及闭合吸引伤口引流的使用减少了与后颅窝胶原基质硬膜成形术相关的并发症。 （DOI：10.3171/2008.10.JNS08993）
Object. Complete dural closure is not always possible following posterior fossa surgery, often requiring a graft to secure complete closure. The authors report their experience of using a collagen matrix as an onlay dural graft for repair of a posterior fossa dural defect.Methods. A retrospective analysis was performed in 52 adult patients who had undergone collagen matrix duraplasty for the posterior fossa. Complications directly related to the dural graft, the presence or absence of hydrocephalus, and the role of closed suction wound drainage in relation to postsurgical pseudomeningoceles were analyzed.Results. The indication for posterior fossa surgery was tumors in 32 patients, vascular abnormalities in 9 patients, and spontaneous cerebellar hemorrhage in I I patients. Closed Suction wound drainage was used in 23 patients (44.2%). Forty-eight (92.3%) of 52 patients had a dural defect >2 cm. Nine (81.8%) of I I patients with hydrocephalus required ventriculoperitoneal shunts. Complications of the surgery included pseudomeningoceles in 2 patients (3.8%; no closed suction wound drainage); superficial wound infections in I patient (1.9%; with closed suction wound drainage); and unexplained eosinophilia in I patient.Conclusions. Duraplasty using a collagen matrix is safe and effective in the posterior fossa, and is easy to use and time efficient. Meticulous layered wound closure, the detection and effective control of hydrocephalus, and the use of closed suction wound drainage reduces complications related to collagen matrix duraplasty for the posterior fossa. (DOI: 10.3171/2008.10.JNS08993)